Implementing a Social Determinants of Health Curriculum in Undergraduate Medical Education: A Qualitative Analysis of Faculty Experience

The neighborhood walk: introducing first-year medical students to social determinants of health in underserved neighborhoods

BACKGROUND

Social determinants of health (SDoH) contribute to up to 80% of an individual's health, underscoring its importance in medical education. Research has shown that community exposure and engagement during undergraduate medical education increases the likelihood of students working in underserved areas in the future. Given the limited research on the feasibility and educational effects of SDoH experiences implemented at the early stages of medical education, this study presents a unique perspective on an interactive learning opportunity during the preclinical curriculum. The purpose of this study is to evaluate the educational impact of an immersive social determinants of health learning intervention for first-year medical students.

METHODS

First year medical students visited one of five underserved neighborhoods in Pittsburgh during Orientation Week. Students received materials about neighborhoods and community engagement etiquette prior to their visit. Visits spanned four hours with two groups of approximately 15 students for each neighborhood, led by at least one faculty member and two student facilitators. Students visited two to four community organizations in each neighborhood and participated in a debrief session. Students completed a feedback survey, and results were analyzed with Chi-square Test of Independence (p < 0.05).

RESULTS

The survey response rate was 58.2%. Students ranked the intervention as "Excellent" (77%), "Above Average" (14%), and "Good" (7%). When asked to rate the comfortability of helping patients obtain community resources on a scale of 1-5, 64.3% of students rated 4 or above. Similarly, 91.6% of students rated 4 or above when asked about knowledge of available resources in their neighborhood. The major learning outcomes from students were richness of community resources/history (35.7%), food insecurity (26.2%), and dissipation of previous stigma (23.8%). There was a significant association between growing up in Pittsburgh and self-rating of comfortableness with helping patients obtain community resources (p = 0.02). Students who completed pre-visit materials were more likely to rate the materials (p < 0.01) and debrief session as helpful (p < 0.01).

CONCLUSIONS

Prior exposure to and information about communities was found to enhance the neighborhood learning experience. This initiative demonstrates the benefit of early engagement with community resources and neighborhood-based health disparities in undergraduate medical education.

Integration of social determinant of health in patient's history-taking in medical education: an educational scholarship and action research study: phase I

BACKGROUND AND OBJECTIVE

One of the most important aspects of health is social health. Addressing social health and social accountability is possible by education of social determinants of health (SDH) to medical students. The aim of current study is to integrate the SDH variables to patient's history-taking in medical education during clerkship stage as an action research and scholarship in education. Pediatric patients were selected as the target population for this study.

METHODS

The present study is an action-research including three phases of the program's design, implementation, and evaluation. The present paper reports the results of phase I including the following steps; rapid scoping review and expert panel for development of history-taking form. The goal of this phase was to prepare an SDH checklist for history-taking in the Pediatrics Ward of Firoozabadi Teaching Hospital, Iran University of Medical Sciences, Tehran, Iran. The checklist of history-taking was evaluated in terms of measurability, feasibility, priority, and clarity using a 5-choice Likert scale.

RESULTS

According to the results of the scoping review and consensus-based methods, the preliminary version of the program was prepared including the SDH history-taking checklist. A total of 21 items were selected after two expert panel rounds. The overall absolute agreement was 0.704 (95% CI: 0.587 - 0.793) which was significantly higher than 0.5 (P < 0.001). The range of scores was 3.5 - 4.83 (out of five).

CONCLUSION

We developed a SDH history-taking form including nine domains and 21 items. This form should be piloted and evaluated by an expert panel in the next phases. The present phase of the project proposed a consensus-based program for the imputation of SDH education in the education program of medical students. The reason for the importance of choosing children is that social factors in the group of children can have a greater impact considering the long life ahead and being in the growing age. After the implementation and evaluation phases, this program may be imputed in the medical education curriculum.

Evidence-Based Strategies for Reforming the Medical Curriculum at the National Autonomous University of Honduras: A Systematic Literature Review

Medical education worldwide has undergone numerous stages of reform. Cultural and financial restraints have decelerated progress in developing countries. Current reforms should focus on creating integrated, competency-based, and student-centered curricula that emphasize patient-centered care. The following review of literature published between 2014 and 2023 on global curricular reforms highlighted key components, challenges, and strategies for implementing or evaluating undergraduate medical programs that prioritize student-centered approaches and competency-based models. This review also compared the current curriculum at the National Autonomous University of Honduras (UNAH) with these international experiences to suggest strategies in order to encourage significant reform. The following review identified 47 articles that provided insights into ideal contexts for curricular reforms, while 15 publications detailed the current state of the UNAH medical curriculum and its potential weaknesses. Additionally, 25 articles discussed specific reforms in other countries, offering valuable results and conclusions for consideration. Drawing from these models and experiences, strategies were proposed for UNAH's curriculum reform, including identifying basic needs, defining project vision, training teaching staff and students, and integrating multidisciplinary teams of experts. Although training all teaching staff abroad may be financially unfeasible, selecting and training key individuals to train others could be a viable alternative. Successful reform requires a comprehensive, periodic, and systematic evaluation. Despite the challenges faced by developing countries, global experiences with alternative reform models offer promising solutions, providing an opportunity for the Faculty of Medical Sciences at UNAH to overcome local limitations and fulfill the primary task of training professionals who are clinically, ethically, and adaptively competent, with a focus on patient-centered and primary care approaches.

Integrating the social determinants of health into curriculum: AMEE Guide No. 162

The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families. This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.

Beyond Empathy to System Change: Four Poems on Health by Bertolt Brecht

Bertolt Brecht's poem "A Worker's Speech to a Doctor" is frequently cited as a means to raise awareness among health workers of the health effects of living and working conditions. Less cited is his Call to Arms trilogy of poems, which calls for class-based action to transform the capitalist economic system that sickens and kills so many. In this article, we show how "A Worker's Speech to a Doctor," with its plea for empathy for the ill, contrasts with the more activist and often militant tone of the Call to Arms trilogy: "Call to a Sick Communist," "The Sick Communist's Answer to the Comrades," and "Call to the Doctors and Nurses." We also show that, while "A Worker's Speech to a Doctor" has been applied in the training of health workers, its accusatorial tone towards health workers' complicity in the system the poem is critiquing risks alienating such workers. In contrast, the Call to Arms trilogy seeks common ground, inviting these same workers into the broader political and social fight against injustice. While we contend that the description of the sick worker as a "Communist" risks estranging these health workers, our analysis of the Call to Arms poems nevertheless indicates that their use can contribute to moving health workers' educational discourse beyond a laudable but fleeting elicitation of empathy for the ill towards a structural critique and deeper systemic understanding in order to prompt action by health workers to reform or even replace the capitalist economic system that sickens and kills so many.